Healthcare Provider Details

I. General information

NPI: 1194202614
Provider Name (Legal Business Name): KATELIN THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 S PALAFOX ST UNIT 300
PENSACOLA FL
32502-5905
US

IV. Provider business mailing address

4724 N DAVIS HWY
PENSACOLA FL
32503-2339
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-1656
  • Fax:
Mailing address:
  • Phone: 850-696-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11007274
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007274
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24462
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: